Basic Information
| Provider Information | |||||||||
| NPI: | 1710644737 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORREIA | ||||||||
| FirstName: | ALEXANDRIA | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8477 S SUNCOAST BLVD | ||||||||
| Address2: | |||||||||
| City: | HOMOSASSA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344465028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008049961 | ||||||||
| FaxNumber: | 3523821146 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 LAKE HUNTER DR | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338031297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8635776063 | ||||||||
| FaxNumber: | 3523821146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2021 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA18453 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.